Imaging evaluation of acute abdominal pain in the pregnant patient

Acute abdominal and pelvic pain during pregnancy presents a unique diagnostic challenge. Many pathologies may mimic signs and symptoms attributed to maternal physiologic adaptations and physical examination findings can be confounded by the gravid uterus. While US and MRI are preferred first-line imaging modalities, CT remains appropriate in selected time-sensitive situations when benefits outweigh risks, particularly when MRI is unavailable or for suspected perforation, ischemia, or complicated obstruction. Etiologies are variable and include obstetric-gynecologic disorders as well as other common entities such as gastrointestinal (including hepatobiliary), genitourinary, or even vascular causes. Prompt diagnosis plays a crucial role in appropriate treatment to ensure optimal maternal and fetal outcomes. This paper will explore the depth and breadth of acute abdominopelvic pathologies during pregnancy.